Duplications of the small bowel are an uncommon group of congenital malformations whose symptoms rarely occur in adults. We report the case of a 21 year-old man who suffered during four years from symptoms related to the ulceration of ectopic gastric mucosa in an ileal duplication (spontaneously resolving peritonitis, pelvic abscess, recurrent gastrointestinal bleeding and chronic abdominal pain). Radiological and endoscopic explorations and a first laparotomy failed to provide the diagnosis. 99m pertechnetate (99mTcO4) scintigraphy demonstrated ectopic gastric mucosa and guided the radiological detection of an ileal ulceration. Injection of 99mTcO4 during a second laparotomy located the ectopic gastric mucosa at the level of a tumefaction found on the mesenteric side of the terminal ileum. Duplication was only recognized at pathological examination of the ileal resection. This case emphasizes the need to evoke a duplication in clinical circumstances like those described in this patient as well as the usefulness of 99mTcO4 in the diagnosis of such a malformation.

Adult↗

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[Role of ileo-anal reservoir anastomosis in the treatment of ulcerohemorrhagic rectocolitis and rectocolic polyposis].

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Anal Canal↗

PubMedDate not supplied

[Consciousness].

"Consciousness" is the feeling that each individual has of his own existence (self-awareness) and also the state which permits him to perceive his environment (consciousness and wakefulness). These two types of consciousness, apparently quite different, are in fact the two converging stems of the perceptions that the nervous system provides to the organism. To explain this better, it is necessary to refer to the evolution of the nervous system organization among the species and to imagine what perception the nervous system provides at each stage of this evolution, or in each species harbouring a nervous system corresponding to a given stage. At the beginning, the role of the nervous system is to protect the organism and only by an automatic and reflex organization. It corresponds to an unconscious alertness which permits to perceive the environment; it is the prefiguration of the future consciousness. Self-awareness seems to appear with the centrencephalic and limbic structures which are the highest part of the nervous system in the inferior mammals and the central part in man. At this stage, acquisition memory and affectivity with its different manifestations (emotions, mood, pain...) are established. This kind of consciousness is difficult to imagine since it is only sensorial and affective. Mental consciousness appears with the mental activity in the cerebral hemispheres. It is more than likely that it exists in the superior mammals though it is impossible to imagine what it corresponds to. It reaches the highest development in the man in whose the frontal lobes have the largest extent. Speech is the most striking figure of this development. At each stage of the evolution, consciousness expresses the nervous system activity, centered on a perception, the level of which corresponds to the improvements occurring at each stage and superadded to the previous ones. Hence it is obvious that consciousness has no specific center or pathway. It relies upon structures that participate in triggering and regulating the nervous activity and that utilize the particular centers of perception and analysis. These structures are: the reticular formation and the diffuse thalamic system.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

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[Essay on pain].

The classical conception of pain, considering it as pertaining to a specific sensation, called pain or nociceptive sensation, ie capable of differentiating between all informations those which are detrimental to the organism, is unsatisfactory. The organization of somesthetic pathways allows to say that this pain sensation, associated with temperature sensation, stems from the most archaic nervous sensation: that of the most primitive organisms, for whom contact provokes a flight reaction. This leads to consider the presence of a "contact" sensation, thermic as well as mechanical, "existential" so to speak, far different from touch sensation which is a discriminatory sensation. Pain appears at one end of a chain, the other end corresponding to cutaneous contacts. These latter contacts are pleasurable or very pleasurable, as typified by sexual contacts. Beyond pain, the archaic nervous function is the origin of a whole defense and protection system for the organism. Pain constitutes the subjective alarm mechanism, triggered off in case of lesion or break of the primitive envelope or of its by-products. This existential sensation, with pain as its most blatant manifestation, has held a central place in the course of evolution: our organism could in this way become aware of its own existence. For all of us it plays an important role in the organization and structuring of our personality.

Afferent Pathways↗

PubMedDate not supplied

[Treatment of primitive trigeminal neuralgia by differential thermocoagulation of Gasser's ganglion (author's transl)].

The authors report their experience in the Treatment of essential Trigeminal Neuralgia with controlled increments of radiofrequency heating from an electrode inserted in the Gasserian ganglion or the posterior rootlets. Assuming that the less myelinated small fibers (A delta and C) are more sensitive to the heat than the heavily myelinated A beta and A alpha fibers, graduate controlled thermo coagulation could produce a differential destruction of pain fibers. 30 patients were treated with this method since 10 months. In all cases, the patients experienced immediate relief. There was no mortality and no neurological morbidity outside the trigeminal nerve. The most serious undesired result has been the production of anesthesia or marked hypesthesia in 10% of our cases.

Electric Stimulation↗